About one out of 100 thousand people develop NPH and it can occur at any age.  However, it typically occurs at senior ages.  Most of its effects are essentially reversible when the condition is recognized and properly treated.  When this condition occurs there is an accumulation of CSF, which causes the ventricles of the brain to enlarge but with little or no increase in sustained pressure.  The name of this condition is a bit misleading because some patients do show fluctuations in pressure that range from low normal to high.  Although hydrocephalus can result from meningitis, brain hemorrhage, brain surgery or tumors in the brain, there is often no medical history that definitely explains the development of NPH. 

  The symptoms and signs of NPH characteristically include complaints of difficulty walking, mild dementia and urinary incontinence.  Patients may demonstrate a wide-based, short, slow and shuffling step that may cause mild imbalance and frequent falls.  The problems with gait are often the most pronounced finding and the first to become apparent.  With longer standing hydrocephalus, mild dementia in the form of forgetfulness, difficulty dealing with routine tasks and short-term memory loss may occur.  The dementia is sometimes also associated with urinary incontinence that is characterized by urgency and in some cases complete loss of bladder control.  Some patients may never develop this sign but it is often the last apparent symptom. 

  Treatment by shunting (diverting) the CSF to another part of the body often reverses the effects of hydrocephalus, allowing patients to lead full and active lives.  There are many different types of shunting systems that work well but one of the most advanced systems now available in the United States is the magnetically programmable valve system manufactured by Johnson & Johnson Professional, Inc.  This is the first shunt of its type and it allows for quick, noninvasive adjustments in valve pressure settings using a small magnet placed over the scalp and shunt.  This allows the neurosurgeon to make precision adjustments in the valve pressure to suit the patient’s needs as opposed to the patient having to adapt to a shunt with a single fixed valve pressure.  This eliminates the need for repeat surgery to replace shunt valves in some patients.  This new shunt technology is the result of bringing together experts in neurosurgery, engineering and interestingly, the watch making and micro technology industries as the very tiny precision parts of this shunt were developed and produced in Switzerland.

 I have recently used this type of shunt in a few patients here and I have been very pleased with the results.  This is a superior advance in shunt technology that will please patients and clearly improve their quality of living.

  NPH is not a hopeless condition; in fact, it is a relatively easily treatable condition.  The  success rate for shunting can be as high as 80%,  but left untreated the condition can cause progressive deterioration.

 
Worldwide Web Resources

Hydrocephalus Association Homepage
http://neurosurgery.mgh.harvard.edu/ha/

The Hydrocephalus Association Homepage provides educational information on hydrocephalus as well as information on services and resources for patients and families.

The Hydrocephalus Foundation, Inc.
http://www.hydrocephalus.org/

  The Hydrocephalus Foundation provides support, educational resources and networking opportunities to patients and families affected by hydrocephalus.